Marking biopsy sites

ABSTRACT

A needle biopsy system for marking a sampling site is described.

TECHNICAL FIELD

This invention relates to marking biopsy sites.

BACKGROUND

The invention relates to the field of biopsy devices.

A needle biopsy device is frequently used to obtain a piece of tissuefor microscopic examination to determine malignancy, while subjectingthe patient to the least trauma. Typically, the instrument consists of along, thin, probe, termed a stylet, within a close-fitting hollowneedle, termed a cannula. The stylet and cannula are controlled manuallyor by a firing mechanism that first projects the stylet into a tissuemass, followed by the cannula. The stylet has a notch into which tissuewill prolapse when the stylet penetrates the tissue mass. As the cannulaslides over the stylet, a small piece of tissue is severed from thetissue mass and captured within the notch of the stylet. The device isthen withdrawn and the piece of tissue removed from the stylet notch. Anexample of a device including a two-stage actuation mechanism in whichthe cutting needle and cannula are advanced in timed sequence underspring actuation is described in Bates, U.S. Pat. No. 4,958,625, theentire contents of which is incorporated herein by reference.

SUMMARY

In an aspect, the invention features a needle biopsy system thatincludes a sampling portion locatable inside the body. The samplingportion includes a stylet having a sampling region and a cannula. Thestylet and cannula are relatively moveable along the stylet axis toposition the cannula over the sampling region. A sample marker islocatable in and releasable from the sampling portion.

In another aspect, the invention features a method of biopsy treatmentby providing a needle biopsy device. The biopsy device includes asampling portion with a stylet having a sampling region, and a cannula.The stylet and cannula are relatively moveable to position the styletover the sampling region. The stylet is inserted into a tissue mass. Thecannula is located over the sampling region by relative motion betweenthe stylet and the cannula. A marker is delivered from the samplingportion into the tissue while removing the stylet from the tissue.

In another aspect, the invention features a method of biopsy treatment.The treatment includes taking multiple biopsy samples from a tissue. Thelocation of each of the multiple samples is marked contemporaneouslywith the taking of each sample. A marker is released into the tissuemass. The marker is detectable by ultrasound, x-ray analysis, ormagnetic resonance imaging. The tissue samples are analyzed. Tissue,corresponding to the location of at least one of the samples, istreated.

In other aspects, the invention features biopsy markers and their use asdescribed below.

Embodiments can include one or more of the following. The sample markeris locatable between the stylet and the cannula. The biopsy system caninclude a marker lumen between the stylet and cannula. The marker lumencan include a supply of multiple markers in the lumen. The markers inthe supply can be arranged sequentially and generally parallel to thestylet. The supply of markers can be provided radially around thestylet. The supply of markers can be rotatable relative to the styletaxis.

The marker lumen can include a marker exit opening adjacent the distalend of the stylet. The stylet can include a side notch and the exitopening can be distal of the side notch. The opening can be oriented toeject a marker substantially parallel to the stylet. The stylet caninclude a side notch and a marker exit opening proximal of the sidenotch. The stylet can include a side notch and at least one marker exitopening aligned with an end of the side notch. A first exit opening canbe located adjacent a first axial periphery of the sampling region and asecond exit opening can be located adjacent the second exit opening. Theexit opening can be in the cannula.

The biopsy system can include a control handle portion. The controllercan include a supply of markers. The system can include a marker pusherto selectively locate markers in the sampling portion. The pusher can beactuated from the handle portion. The marker can be indicative of theaxial length of a tissue region from which a sample is taken. The markercan include an elongated element. The elongated element can includeregions along its length distinguishable by MRI, ultrasound orfluoroscopy. The distinguishable regions can be spaced to indicate thelength of a tissue region from which a sample is taken. At least aportion of the marker can be bio degradable.

The biopsy system can include a supply of markers. A given marker can bedistinguished by MRI, ultrasound or fluoroscopy from another marker inthe supply. The marker can include a tissue engaging edge that resistsproximal motion of the marker when the marker is in contact with thetissue.

A marker can be magnetically fixed to the exterior of the stylet. Themarker can be axially translatable by motion of the cannula to releasethe marker. The marker can be translated to a location where it ismagnetically repulsed from the cannula.

The method can include inserting the stylet into the tissue mass asecond time and delivering a second marker into the tissue mass. Themarkers can be distinguished by ultrasound, fluoroscopy or magneticresonance.

The method can include correlating the markers with the location of themultiple tissue samples. The method can include analyzing the samplesfor abnormal indication, and treating a portion of the tissue mass. Themethod can include analyzing the tissue samples for cancerousindication.

Embodiments may include one or more of the following advantages. Thebiopsy device can take biopsy samples at various sites in the body, forexample, in the prostate, and concurrently deliver a marker, such as aradiopaque marker, to the site. The marker can be delivered to the sitethrough the sampling portion of the biopsy device so that the devicedoes not have to be removed before marker placement. The marker can bedeployed to indicate the ends of the site. The marker can be at leastpartially biodegradable. When several samples (e.g., 3-12) are taken,the device can deliver markers that can be distinguished from oneanother by e.g. ultrasound, fluoroscopy, MRI or a combination oftechniques. For example, the markers can be differently shaped and/orsized radiopaque markers. Marking the biopsy site facilitatesnon-invasive and continued monitoring of the biopsy site, which enableseffective treatment strategies to be devised. For example, a therapeuticdevice or agent can be guided by and located between the markers totract a site.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,aspects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

Like reference symbols in the various drawings indicate like elements.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a side view of an embodiment of a needle biopsy device.

FIG. 2A is a cross-sectional view of the control handle of the device ofFIG. 1.

FIG. 2B is a cross-sectional side view illustrating the path of a pusherthrough a guide tube, stylet and cannula within the control handle inFIG. 1.

FIG. 2C is a cross-sectional view of the sampling region of the deviceof FIG. 1.

FIG. 2D is a cross-sectional view taken along C-C of FIG. 2B.

FIG. 2E is side view of a marker.

FIGS. 3A-3F are expanded cross-sectional views of the control handle andthe sampling region of the device of FIG. 1, with FIG. 3A illustratingthe device in neutral condition before sampling, FIG. 3B illustratingthe device with the stylet and cannula both armed, FIG. 3C illustratingthe device after the stylet has been fired and the cannula armed, FIG.3D illustrating the device after the cannula has been fired; FIG. 3Eillustrating the device after initiation of marker deployment; and FIG.3F illustrating the device being withdrawn from the body and the markerbeing placed in the biopsy site.

FIG. 4A is a side view of another embodiment of a needle biopsy device.

FIG. 4B is a cross-sectional side view of the control handle of thedevice of FIG. 4A.

FIG. 4C is a perspective expanded view of a marker cartridge.

FIG. 5A is an expanded perspective view of the sampling region inanother embodiment of the needle biopsy device.

FIG. 5B is a cross-sectional view of components in a control handle anda sampling region in the embodiment of FIG. 5A.

FIG. 5C is a cross-sectional view of components in the sampling regionin the embodiment of FIG. 5A.

FIG. 6 is a cross-sectional side view of the sampling region in anotherembodiment of a needle biopsy device.

FIGS. 7A and 7B are cross-sectional side views of the sampling region inanother embodiment of a needle biopsy device.

FIG. 8 is a schematic of a marker.

DETAILED DESCRIPTION

Structure

Referring to FIGS. 1-2B, a biopsy device 5 includes a control handle 6and a sampling portion 7. The sampling portion 7 includes a stylet 18with a sample notch 30 and a concentrically arranged cannula 20. Thestylet 18 and cannula 20 project from the control handle 6. To take asample, the stylet 18 and the cannula 20 are retracted to an armedcondition using control buttons 12, 14 on the control handle 6. Theretracted stylet and cannula compress respective springs 44 and 40 inthe control handle 6. The sampling portion 7 is located adjacent thetissue from which a sample is to be taken. The device is fired byactuating a firing button 22 which releases the stylet spring 44,causing the stylet 18 to be extended such that it pierces a tissue mass.The cannula spring 40 is subsequently released to extend the cannula 20which severs a sample from the tissue mass. The sample is captured inthe sample notch 30 on the stylet 18.

During the sampling procedure, the device can be monitored inside thebody or tissue mass by, e.g., ultrasound, fluoroscopy or MRI. After asample is taken, the device is removed from the body and the sampleretrieved from the notch for analysis. Organs in which this procedurecan be carried out include the prostate, kidney, uterus, breast, orother suspected tumor sites. The sampled area can be treated as needed,e.g., by tissue ablation therapy using RF ablation, induction heating,interstitial laser ablation, hypothermia therapy, cryotherapy, alcoholinjection, and administration of a sclerosing agent. Typically thesetechniques include delivering a catheter or other instrument to locallytreat the area around the biopsy site and avoid damaging adjacenthealthy tissue. The treatment can also be monitored by ultrasound,fluoroscopy or MRI. A suitable firing arrangement is described in Bates'675, incorporated supra.

Referring particularly to FIGS. 2C and 2D, the sampling portion 7carries multiple elongated markers 19, 19′, 19″ etc. The markers 19,19′, 19″ are located end to end in a lumen 27 that is substantiallyparallel to the axis of the stylet 18. The lumen 27 terminates at itsdistal end in an opening 29 through which the markers can be ejected, aswill be described below. The lumen 27 is defined by a slot 32 on theouter surface of the stylet 18 and the inner surface of the cannula 20(FIG. 2D).

Referring as well to FIG. 2A, a pusher 75 is controlled by a slide 23 onthe control handle. Referring particularly to FIG. 2B, an enlarged viewwhich illustrates the path of the pusher into the lumen 27 in thecontrol handle with other components removed, the pusher 75 is directedby a guide tube 25 to the groove 32 at the proximal end of the stylet.Referring particularly to FIG. 2C, the distal end of the pusher 75engages the proximal end of the most proximal marker 19″. By actuatingthe slide 23 proximally the pusher 75 moves distally so that the markers19, 19′, 19″ are pushed distally, and the most distal marker 19 isejected through opening 29.

Referring particularly to FIG. 2E, each marker 19, 19′, 19″ includes arod portion 33, a tip portion 31, and two bands 35, 35′. The bands 35,35′ can be distinguished from the rod portion 31 by ultrasound,fluoroscopy, and MRI. The bands 35, 35′ are fixed to and spaced alongthe rod portion 31 at a distance that approximately equals the length ofthe stylet notch 30 and can thus indicate the extension of a samplingsite. In addition, the rod portion 31 maintains the bands 35, 35′ in adefined orientation relative to one another so that the relative planeor perspective of the bands 35, 35′ as viewed by ultrasound, etc., isdetectable. In addition, the marker bands 35, 35′ and the tip portion 31have a larger cross-section than the rod portion 33, which facilitates afriction fit of the markers in the lumen 27 so that they are notprematurely ejected. The larger profile also inhibits motion of themarkers after deployment in the body.

The bands 35, 35′ can be made of a material that is detectable bydiagnostic technique(s) such as ultrasound, MRI, and x-ray fluoroscopy.For radiopaque marker bands, a high density metal such as tantalum,platinum, gold, or stainless steel can be used. In embodiments,materials with a density of 10 g/cc or more can be used. The bands canbe solid metal or a metal combined in polymer matrix. For ultrasoundvisibility, metal bands can be used and/or coatings of materials, e.g.,polymers, differentiatable based on acoustic impedance can be used. ForMRI detection, materials having different resonant signatures, e.g.,different magnetic susceptibility can be used. Examples includematerials that produce a magnetic field that disrupts T1 or T2 ofsurrounding protons. Suitable materials include paramagnetic andferromagnetic materials, such as gadulinium-based materials andiron-based materials. A supply of markers can be provided such that eachmarker has a band or bands or associated shapes, which can bedifferentiated from the bands on other markers so that multiple biopsysites can be readily distinguished. For example, for radiopaque bands,the paired bands on different markers may have different identifyingconfigurations (circular, lines or rings, such as one line/ring ateither end of the bands or two lines/rings at either end, triangular,square, donut, hex, etc.) or sizes. In embodiments, the bands on eachmarker can also be distinguishable from one another by shape, size ormaterial. Bands on different markers or the bands on a given marker maybe constructed to enhance visibility by different diagnostic techniques.For example, one band may include a high density metal to enhanceradiopacity for fluoroscopic visibility, while another band includes aferromagnetic material for enhanced MRI visibility.

In embodiments, the tip 31 and rod 33 portions can be made of a polymer,such as a bioabsorbable or biodegradable polymer, e.g., polylactic acidand polyglycolic acid. In embodiments, the biodegradable polymerdissolves rapidly leaving the less or generally non-degradable markerbands in the body for viewing over a longer period of time. In theembodiment illustrated, the tip portion 31 has a triangularcross-sectional shape which has a gradual taper that facilitates distalmotion into tissue but resists proximal motion. Other tip portion shapesinclude hook-shapes and barbs. The tip portion can be a continuousextension of the rod portion. The tip and rod portions can be formed,e.g., by molding. The bands can be attached, e.g., by an adhesive. Inembodiments, the bands can be integral with the rod, e.g. molded of thesame polymer. In embodiments, the tip and/or rod portions can be made toenhance visibility by diagnostic techniques as discussed above. Forexample, the tip and/or rod can be metal or include a metal.

In an embodiment the overall length of the marker is about 0.75 inches.The diameter of the rod portion is about 0.005-0.006 inches. The markerbands have an axial width of about 0.03 inches and a spacing (inner edgeto inner edge) of about 0.6 inches. The markers and the tip portion havea maximum diameter of about twice the rod diameter. A suitable cannulaand stylet have a length of about 10 inches, and can accommodate, e.g.,4-6 markers.

The pusher 75 can be made of a material with sufficient column strengthto transmit the force needed to eject the markers. The pusher 75 alsohas sufficient flexibility to follow a circuitous path in the handle.Suitable materials include metal wire made, for example, of a highlyflexible metal such as nitinol, or polymer filament. The pusher 75 canbe directed along a path in the handle defined, e.g., by a guide tube25. The guide tube guides the pusher around a clockwise path and directsthe pusher into the stylet slot at the proximal end of the stylet. Theamount of slide motion for marker ejection can be indicated by visualmarks or detents on the control handle. Slide 23 can include a lock,e.g., an element moveable in the slide path, to prevent motion of slide23. The lock can be engaged, e.g., after one marker has been ejected, toprevent more than one marker from being placed at one biopsy site. Inother embodiments, rather than following a path entirely in the controlhandle, the pusher may extend from the proximal end of the controlhandle and urged distally by linearly pushing it into the control handleand the lumen 27.

Use

Referring now to FIG. 3A et seq., a biopsy procedure including placementof a marker at the site of tissue removal is illustrated. Each figureillustrates expanded cross-sectional views of the control handle 6 andthe sampling region 7.

Referring to FIG. 3A, the device is in the neutral position, e.g., priorto use. The stylet 18 and cannula 20 are both extended with the cannula20 covering the sample notch 30 of stylet 18. The sampling portionincludes a supply of markers 19, 19′, 19″ etc., in the lumen 27. Themarkers 19, 19′, 19″ can be loaded into the lumen 27 through the opening29. The markers are pushed into the lumen 27, e.g. using a wire so thatthe end of pusher 75 is adjacent the proximal end of the most proximalmarker 19″.

Referring to FIG. 3B the cannula 20 and stylet 18 are armed for firing.In this condition, the stylet 18 and cannula 20 have been retractedtoward the control handle 6.

Referring to FIG. 3C, to take a sample, the stylet 18 is fired, causingthe stylet 18 to project into a tissue mass 21.

Referring to FIG. 3D, the cannula 20 is fired. The cannula 20 severs asample 37 from the tissue, which prolapses into the notch 30 of stylet18. (Because of the rapid motion of the cannula, the markers in thelumen 27 remain substantially in the same location as the stylet 18 andcannula 20 are fired).

Referring to FIG. 3E, without removing the device from the body, amarker is placed at the biopsy site by moving slide 23 toward theproximal end of control handle 6 (arrow). This motion of slide 23 movespusher 75 through guide 25 around a clockwise path, and then distally inthe lumen 27, pushing the markers 19, 19′, 19″ distally. Slide 23 ismoved a distance such that the bands 35, 35′ on marker 19 areapproximately at the proximal and distal ends of the notch 30 and themarker tip 31 is exposed from the opening 29. The marker tip 31 engagesthe tissue adjacent the distal end of the sampling site and lodges themarker at the site.

Referring to FIG. 3F, the sampling portion 7 is withdrawn. As thesampling portion 7 of device 5 is withdrawn from the site (arrow), themarker position is maintained by the tip 31. The bands 35, 35′remainpositioned at the two ends of the biopsy site. Alternatively, the pusher75 may be activated to completely eject a marker at or near the site,e.g. as the device is being removed.

Other Embodiments

Referring to FIGS. 4A-C, in another embodiment, a supply of markers iscarried in a control handle. The control handle includes a markercartridge 72, which includes lumens 77 that hold markers 19, 19′, 19″.The marker cartridge 72 can be moved along a railing 74 using a slidebutton 80 so that a slot containing a marker is axially aligned with thelumen 27 of stylet 18. Pusher 75 is actuated so that the distal end ofthe pusher enters a slot in the cartridge to push the marker from thecartridge into the lumen 27, and to eject marker through opening 29 intothe site. After a marker placement, the pusher is retracted so itsdistal end is proximal of the cartridge, and the marker cartridge isslid along the railing 74 placing another slot containing a marker inalignment with lumen 27. A subsequent sample can then be taken and thesite marked.

Referring to FIGS. 5A-5C, in another embodiment, a sampling region 200includes a stylet 210, a rotary cartridge 220, a rotary control tube 230and a cannula 240. The stylet 210 includes a body 202 that extends to atip 204. The tip 204 has a sample notch 30 and a marker guide 206. Thecartridge 220 is rotatably positioned over the stylet body 202. Therotation control tube 240 extends from the proximal end of cartridge220. The cartridge 220 has a plurality of slots 214, to accommodatemarkers 19. The slots 214, and the markers 19 contained within theslots, can be sequentially brought into axial alignment with the markerguide 206 on the stylet tip 204 by rotating cartridge (arrow) relativeto the stylet. The cannula 230 has a marker opening 224 through whichmarkers can be ejected.

Referring to FIG. 5B, when the cannula 230 is extended distally to coverthe notch in the stylet tip 204, the marker opening 224 of cannula 240is vertically aligned with the marker guide 206 of stylet tip 204. Theguide 206 is angled, (e.g. 25-50°) to guide a marker through the opening224. A pusher 75 enters a slot 276 in the proximal end of the styletbody. The pusher 75 extends through the stylet body to an opening 279proximally adjacent the cartridge 220. Referring to FIG. 5C, after asample is taken, the pusher 75 can be actuated distally to slide amarker from the cartridge slot 214 to the marker guide 206 of stylet tip204. The marker is ejected through the marker opening 224 and placed atthe sampling site.

To mark another sample site, the pusher is retracted from the cartridge,and the rotation control tube 240 is actuated. The rotation control 240includes at its distal end the cartridge 220. The tube 240 is arrangedconcentrically over the stylet body and extends proximally to thecontrol handle and terminates in a control knob 260. The control knob260 can protrude through the control handle body where it can beaccessed by the user. By rotating the control knob 260, the user canrotate the cartridge 220 to bring marker grooves 214 sequentially intoalignment with the marker guide 206. In addition, the control knob 260can be retracted proximally to retract marker cartridge 220 proximallywhen the stylet is armed. The control knob 260 can be extended distallyafter the device has been fired to position the cartridge 220 adjacentthe marker guide 206. Alternatively, the control tube and cartridge canbe retracted with the stylet. In the embodiment described above, themarker is ejected at a radial location corresponding to the location ofthe stylet notch. In embodiments, the pusher and guide can be arrangedto eject the marker at other radial locations, e.g. 180° opposite thenotch.

Referring to FIG. 6, in another embodiment, a sampling region 50includes discrete bands 47, 47′, 47″ etc., which are spaced by separaterods 49, 49′, 49″ etc., within lumen 27. In this embodiment, the bandsare not fixed to rods. Cannula 20 has two apertures 53 and 55 positionedadjacent the ends of the stylet notch 30 when the cannula is over thenotch 30.

Marking a biopsy site is accomplished as follows. After severing asample and without removing the device from the body, bands 47, 47′,47″, and rods 49, 49′, 49″, are moved distally (e.g., using a pusher 75)such that the bands are brought into alignment with and fall throughaperture 53 and aperture 55 (by gravity), marking the ends of a biopsysite. Sets of bands may be shaped or otherwise modified to differentiatemultiple sites. The rods are ejected from the opening 29 of the lumen27.

Referring to FIGS. 7A and 7B, in another embodiment, a sampling portion400 includes a stylet 402 and a cannula 404. The stylet 402 includes asample notch 403. The stylet includes two pairs of magnets 406, 406′,and 408, 408′ on either side of the notch 403. Magnets 406, 408, areoriented to have their positive poles outwardly directed and magnets406′, 408′, have their negative poles outwardly directed. The devicealso includes magnetic marker bands 410, 410′ (exploded in FIG. 7A). Thecannula includes openings 412, 412′ from which the bands 410, 410′ canbe released when the bands are aligned with repellant magnetic poles.

Referring particularly to FIG. 7A, the device is illustrated in an armedcondition. An optional protective sheath 414 can be provided. The bands410, 410′ are positioned in the cannula openings 410, 410′ and alignedwith magnet poles to which they are attracted. In this example, bandsare attracted to the negative poles on magnets 406′, 408′.

Referring particularly to FIG. 7B, the sampling portion is illustratedafter the device has been fired and a tissue sample 416 has beencaptured in the notch 403. In the post-fired condition, the cannulaopenings 412, 412′ and the bands 410, 410′ are aligned with the positivepoles of magnets 406, 408, which repel the bands. The bands are thusrepelled by the magnets and exit the cannula opening to mark thesampling site. The relative position of the stopped cannula betweenFIGS. 7A and 7B is controlled by, e.g., a stop in the control handlethat limits the extension of the cannula or stylet in the firedcondition. In the example illustrated, in the armed condition, thestylet and cannula are in alignment at point A. In the fired condition,the stylet extends relative to the cannula to point F.

In embodiments, the shape of the band is dish-shaped (concave) with therim being at a higher elevation than the center and located with the rimedge closest to the outside diameter of the cutting cannula outsidediameter. The device actuation advances the biopsy needle into thetissue, followed in a timed sequence by the cutting cannula. Therepelling force need be only strong enough to cause the dish radiopaquemarker to cock slightly, raising the leading edge above the cuttingcannula surface. This provides a cam surface to help strip the band fromthe device and maintain a marker on both ends of the tissue sample.

Referring to FIG. 8, a marker 300 is illustrated. The marker 300includes a series of adjacent barbs 310, 312, 314, 316, 318 along itsbody. Barbs 312, 316 are constructed for enhanced diagnostic visibilitycompared to barbs 310, 314, 318, as discussed above with respect tomarker bands. The spacing between the barbs 312, 316 may be selected,e.g. to indicate the length of a sampling site.

Still other embodiments are within the claims. For example, a rotarycartridge holding multiple markers can be used in the embodiment of FIG.4 et seq.

1. A needle biopsy system, comprising: a sampling portion locatableinside the body and including a stylet having a sampling region and acannula, the stylet and cannula relatively moveable along the styletaxis to position the cannula over the sampling region, and a samplemarker locatable in and releasable from the sampling portion.
 2. Thesystem of claim 1 wherein the sample marker is locatable between thestylet and the cannula.
 3. The system of claim 1 including a markerlumen between the stylet and cannula.
 4. The system of claim 3 includinga supply of multiple markers in the lumen.
 5. The system of claim 4wherein the markers in the supply are arranged sequentially andgenerally parallel to the stylet.
 6. The system of claim 2 wherein saidsupply of markers is provided radially around said stylet.
 7. The systemof claim 6 wherein the supply of markers is rotatable relative to thestylet axis.
 8. The system of claim 3 including a marker exit openingadjacent the distal end of the stylet.
 9. The system of claim 8 whereinthe stylet includes a side notch and the exit opening is distal of theside notch.
 10. The system of claim 9 wherein the opening is oriented toeject a marker substantially parallel to the stylet.
 11. The system ofclaim 3 wherein the stylet includes a side notch and a marker exitopening proximal of the side notch.
 12. The system of claim 3 whereinthe stylet includes a side notch and at least one marker exit openingaligned with an end of the side notch.
 13. The system of claim 12wherein a first exit opening is located adjacent a first axial peripheryof the sampling region and a second exit opening is located adjacent thesecond exit opening.
 14. The system of claim 12 wherein the exit openingis in the cannula.
 15. The system of claim 13 wherein the exit openingis in the cannula.
 16. The system of claim 1 including a control handleportion, the controller having a supply of markers.
 17. The system ofclaim 1 including a marker pusher to selectively locate markers in saidsampling portion, the pusher being actuated from the handle portion. 18.The system of claim 16 including a marker pusher to selectively locatemarkers in said sampling portion, the pusher being actuated from thehandle portion.
 19. The system of claim 1 wherein the marker isindicative of the axial length of a tissue region from which a sample istaken.
 20. The system of claim 19 wherein the marker includes anelongated element.
 21. The system of claim 20 wherein the elongatedelement includes regions along its length distinguishable by MRI,ultrasound or fluoroscopy.
 22. The system of claim 21 wherein saiddistinguishable regions are spaced to indicate the length of a tissueregion from which a sample is taken.
 23. The system of claim 22 whereinat least a portion of the marker is bio degradable.
 24. The system ofclaim 1 including a supply of markers, a given marker beingdistinguishable by MRI, ultrasound or fluoroscopy from another marker inthe supply.
 25. The system of claim 1 wherein the marker includes atissue engaging edge that resists proximal motion of the marker when themarker is in contact with the tissue.
 26. The system of claim 1 whereina marker is magnetically fixed to the exterior of the stylet.
 27. Thesystem of claim 26 wherein the marker is axially translatable by motionof the cannula to release the marker.
 28. The system of claim 27 whereinthe marker is translated to a location where it is magnetically repulsedfrom the cannula.
 29. A method of biopsy treatment, comprising:providing a needle biopsy device including a sampling portion with astylet having a sampling region and a cannula, the stylet and thecannula relatively moveable to position the stylet over the samplingregion, inserting the stylet into a tissue mass, causing relative motionbetween the stylet and the cannula to locate the cannula over thesampling region, and while removing the stylet from the tissue,delivering a marker from the sampling portion into the tissue.
 30. Themethod of claim 29 including: inserting the stylet into the tissue massa second time and delivering a second marker into said tissue mass. 31.The method of claim 30 wherein the markers are distinguishable byultrasound, fluoroscopy or magnetic resonance.
 32. The method of claim31 comprising correlating the markers with the location of the multipletissue samples, analyzing the samples for abnormal indication, andtreating a portion of said tissue mass.
 33. A method of biopsytreatment, comprising: taking multiple biopsy samples from a tissue,marking the location of each of said multiple samples bycontemporaneously with the taking of each sample, releasing a marker inthe tissue mass, the marker being detectable by ultrasound, x-ray, ormagnetic resonance imaging, analyzing the tissue samples, and treatingtissue corresponding to the location of at least one of the samples. 34.The method of claim 25 comprising: analyzing the tissue samples forcancerous indication.